AMA Journal of Ethics®

Illuminating the art of medicine

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. April 2011, Volume 13, Number 4: 207-267.

|

April 2011 Contents

The "R" Word—Ethical Allocation of Medicine's Services

Ethics Poll

The cost effectiveness of a medical intervention is often expressed in the number of "quality-adjusted life years" (QALYs) the intervention is expected to add to an individual's life. Which of the following best expresses what you know about QALYs?

I have talked about QALYs with others.

I have heard or read the term, but don't know how it is calculated or applied.

I have never heard or read about the term before.

The National Institute for Health and Clinical Excellence in the U.K. has used a cost per QALY of 30,000 pounds sterling (approximately $48,000) as the benchmark for its publically funded health service. A treatment that costs less than $48,000 per quality-adjusted life year gained will generally be approved, and an intervention costing more will be refused. By this criterion, even treatments with positive clinical outcomes will be unavailable from the National Health Service if their cost per QALY exceeds the threshold. If the U.S. were to apply the cost-per-QALY concept to its publically funded health programs, Medicare and Medicaid, what do you think the benchmark of cost per QALY should be?

Less than $50,000 per QALY.

Between $50,000 and $100,000 per QALY.

Between $100,000 and $250,000 per QALY.

More than $250,000 per QALY.

Many people have pointed out that rationing of scarce medical resources has always been with us. People have access to medical services they can afford or their insurers (including the U.S. government) have agreed to cover. What do you think is the best way for allocation of scarce medical resources, i.e., rationing decisions, to be made?

The way they've always been made, on the basis of what people could afford or the insurer was willing to pay.

By state legislatures.

By the federal government.

By a public process in which medical experts and the people affected by the decision would have input.